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Optimization process

Introduction

The optimization of clinical practice is the process requiring a diagnostic outcome for a patient from an imaging procedure while minimizing the factors that cause patient detriment. Along with radiation related considerations, these factors include adverse patient contrast media reactions in computed tomography (CT) and interventional radiology procedures.

Important Principles

Optimization is a multidisciplinary task that starts with an audit of image quality and radiation dose throughout the department. This should be done on an X ray room-by-room basis since radiation dose, and image quality, can vary significantly from room-to-room

There are specific steps for a successful optimization process such as:

  1. Establishment of a quality assurance programme; a mistake, misuse or malfunction of an Xray unit can potentially affect the health or life of large number of people.
  2. Establishment of an optimization team consisting at a minimum of a radiologist, a CQMP and medical radiation technologist. Each of these professionals has a unique role in the optimization process. The radiologist provides feedback on whether sufficient task-specific image quality is maintained, the medical physicist optimizes the exam protocol and the radiation technologist ensures that the modified (optimized) exam protocol is feasible in the clinical workflow and executed correctly. At larger or more resourced institutions, the optimization team can include also an engineer and members of the department management.
  3. Determination of baseline dose levels and image quality as well as comparisons with benchmarks to decide which exam protocols should be optimized.
  4. Modification of protocols by the CQMP. He/she should emerge and take a proactive lead in the everyday clinical routine in order to promote the value of optimization process.
  5. Regular review of patient dose and image quality. After implementation, the optimization process should be repeated to determine its effectiveness.

Introduction to References

There is a significant amount of information in the literature illustrating optimization examples in medical imaging. Many references are provided in the Essential and Supplemental References.